1. Managing and Correcting a "Frozen" Leaflet after TAVR
G. Maluenda, I. Ben-Dor, S. Goldstein, Z. Wang, P. Corso, L. Satler, R. Waksman, A. Pichard.
Interventional Cardiology
Washington Hospital Center

2. Disclosure Statement of Financial Interest
I, Gabriel Maluenda DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

3. Clinical presentation
History
89 yo male, 76 Kg, 163 cm; s/p CABG, A.Fib, presented with progressive CHF and syncope. EF 30%, NYHA class IV.
BAV performed 3 month prior to TAVR.
STS 15.1%
Coronary angiogram
Severe native 3 vessel disease. Patent SVG to OM2 and LIMA to LAD. Occluded SVG to RCA. Thoracic aorta within normal dimensions.

4. Stress TTE After infusion of 20 mcg of DBT: V Max: 3.4 to 4.1 to m/sec
Mean gradient: 30 to 41 mm Hg
EF: 30 to 35%
Aortic valve area: 0.75 cm2
Annulus: 20 mm
BASELINE
DBT 20 mcg

6. Baseline Hemodynamics
Mean aortic gradient: 31 mm Hg
Aortic valve area: 0.6 cm2
CO: 2.9 L/min

7. Edwards 23 mm Sapien Valve deployment

8. LV/Ao pressures after deployment

9. Patient developed severe hypotension and massive central AR noted on TEE

10. Multipurpose catheter probing of implanted valve

11. Aortic pressure during and after catheter probing

12. LV/Ao pressures after AR resolved

13. Clinical Course
AR was resolved after catheter probing with concomitant improvement on hemodynamic status
Procedure was performed completely percutaneously and patient was discharge 4 days after TAVR with trivial AR on echo. All leaflets moving normally.

14. Teaching points
Massive central AR is uncommon after TAVR, and can be related to valve dysfunction, usually due to a “frozen” leaflet
Catheter probing of the “frozen” leaflet can restore normal excursion.